Every day in the United Kingdom hundreds of people present to front-line NHS healthcare professionals because of concerns about exposure to medicines, drugs or chemicals. These exposures commonly involve unintentional contact with substances found in households or gardens and, although they occur in all age groups, they are particularly common in young children. Exposures also commonly occur as medicine overdoses in the context of self-harm or as a result of drug misuse, with adolescents and younger adults disproportionately involved. Occupational exposures or involvement of natural toxins such as snake envenomation are less common.

The National Poisons Information Service (NPIS) is commissioned by the UK Health Security Agency (UKHSA) to provide this clinical support, which acts on behalf of the English Department of Health and Social Care (DHSC), the Scottish Government, the Welsh Government and the Northern Ireland Department of Health. The NPIS also provides services to the Republic of Ireland, commissioned by Beaumont Hospital, Dublin, on behalf of the Irish Government. 

Poisoning is an important public health issue, with poisoning incidents as a percentage of all emergency department diagnoses continuing to increase year on year. In England alone, there have been over 350,000 hospital presentations per year for the period 2018 to 2019 through to 2021 to 2022 where the primary or secondary diagnosis was poisoning (including overdose) (1)*. These episodes may involve accidental exposures, medication errors, selfharm or drug misuse. Many more patients are managed in the community, including by primary care and NHS patient advice services such as NHS 111, NHS 24 and NHS Direct. While the majority of episodes do not produce severe clinical effects, several thousand people die each year as a result of poisoning. The National Poisons Information Service (NPIS) is commissioned to provide 24-hour information and advice to NHS healthcare professionals across the UK to support the management of patients with suspected poisoning. This information is provided primarily via TOXBASE, an online database containing information on more than 21,000 agents. TOXBASE is also available as an app which users can access both on- and offline. A 24hour telephone advice service, staffed by specialists in poisons information and supported by consultant clinical toxicologists, is also available for more complex cases if required. The availability of this expertise avoids unnecessary hospital referrals and admissions for patients at low risk of harm, while improving the quality of treatment and shortening hospital stay for those with clinical toxicity. The UK Teratology Information Service (UKTIS) provides information and advice nationally about exposures to drugs and chemicals during pregnancy.

P.47 The number of NPIS telephone enquiries and the volume of TOXBASE online and app accesses give an indirect indication of the drugs of misuse most commonly encountered by health professionals using our service. These data can be used to follow trends with time, including the emergence of new substances, and to characterise features of toxicity reported for different substances. These data are useful for monitoring and assessing toxicity relating to drugs of misuse and are shared periodically with responsible agencies including the Office for Health Improvement and Disparities (OHID), the UKHSA and the Advisory Council on the Misuse of Drugs (ACMD). 

We continue to watch NPIS activity carefully in regard to synthetic opioids, given the harm they have caused globally. NPIS received only 1 telephone enquiry for synthetic opioid toxicity, specifically for furanylfentanil, although we recognise that it is not possible for clinicians to identify synthetic opioids from classical opioids without laboratory analysis. TOXBASE accesses for synthetic opioids remain low and similar to last year with 212 accesses. However, the pattern of substances involved has changed this year with a reduction in accesses for nitazene compounds, especially isotonitazine which is now the second most common nitazene behind metonitazine. Other synthetic opioids have increased their NPIS activity, such as desomorphine (27 accesses), tianeptine (23 accesses) and cyclopentylfentanil (18 accesses).  NPIS telephone enquiries for benzodiazepines were dominated by diazepam (25 calls) and alprazolam (25 calls) while novel benzodiazepine calls were rare – 1 for tofisopam and 1 for flualprazolam only. TOXBASE activity for novel benzodiazepines included etizolam (147 accesses), tofisopam (69 accesses), nitrazolam (53 accesses) and clonazolam (47 accesses).